Journal
CHEST
Volume 159, Issue 3, Pages 924-932Publisher
ELSEVIER
DOI: 10.1016/j.chest.2020.10.050
Keywords
adherence; asthma; biologic; inhaled corticosteroid
Categories
Funding
- NIH/NHLBI grant [HL140287]
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery
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This study reveals that adherence to asthma biologics is higher than to ICS and is associated with different factors. Adherence to ICS before starting asthma biologics and during the first 6 months of biologic use is significantly related to biologic adherence, but not significantly associated with a reduction in asthma exacerbations.
BACKGROUND: Little is known about adherence to asthma biologics. RESEARCH QUESTION: Is adherence to inhaled corticosteroid (ICS) associated with subsequent asthma biologic adherence? STUDY DESIGN AND METHODS: We analyzed individuals with asthma who started asthma biologics in the OptumLab Data Warehouse and used that data until October 2019. We calculated proportion days covered (PDC) for ICS +/- long-acting beta-agonists in the 6 months before and after asthma biologics were started and asthma biologic PDC for the first 6 months of use. We performed a multivariable analysis to identify factors associated with asthma biologic PDC >= 0.75, ICS PDC >= 0.75 during the 6-month period after asthma biologic were started, and achievement of a >= 50% reduction in asthma exacerbations during the first 6 months of asthma biologic use. RESULTS: We identified 5,319 people who started asthma biologics. The mean PDC for asthma biologics was 0.76 (95% CI, 0.75-0.77) in the first 6 months after starting, higher than the mean PDCs for ICS in the 6 months before (0.44 [95% CI, 0.43-0.45]) and after (0.40 [95% CI, 0.39-0.40]) starting the asthma biologic. PDC >= 0.75 for ICS 6 months before index biologic use is associated with PDC for asthma biologics >= 0.75 (OR, 1.25; 95% CI, 1.10-1.43) and for ICS during the first 6 months of biologic use (OR, 9.93; 95% CI, 8.55-11.53). Neither ICS PDC >= 0.75 (OR, 0.92; 95% CI, 0.74-1.14) nor asthma biologic PDC >= 0.75 (OR, 1.15; 95% CI, 0.97-1.36) is associated with a statistically significant reduction in asthma exacerbations during the first 6 months of asthma biologic use among people with any exacerbation in the 6 months before first use. INTERPRETATION. Adherence to asthma biologic is higher than to ICS and is associated with different factors.
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